title: Late initiation of HAART among HIV-infected patients in Spain is frequent and related to a higher rate of virological failure but not to immigrant status.
abstract: OBJECTIVE
  To determine whether immigrant status is associated with late initiation of highly active antiretroviral treatment (HAART) and/or poor response to antiretrovirals.
  
  
  METHODS
  GESIDA 5808 is a multicenter, retrospective cohort study (inclusion period January 2005 through December 2006) of treatment-naïve patients initiating HAART that compares HIV-infected patients who are immigrants with Spanish-born patients. A late starter (LS) was defined as any patient starting HAART with a CD4+ lymphocyte count <200 cells/μL and/or diagnosis of an AIDS-defining illness before or at the start of therapy. The primary endpoint was time to treatment failure (TTF), defined as virological failure (VF), death, opportunistic infection, treatment discontinuation/switch (D/S), or missing patient. Secondary endpoints were time to treatment failure as observed data (TTO; censoring missing patients) and time to virological failure (TVF; censoring missing patients and D/S not due to VF).
  
  
  RESULTS
  LS accounted for 56% of the patients. Lower educational and socioeconomic level and intravenous drug use (IVDU) were associated with categorization as LS, but immigrant status was not. Cox regression analysis (hazard ratio [HR]; 95% CI) between LS and non-LS patients showed no differences in TTF (0.97; 0.78-1.20) or TTO (1.18; 0.88-1.58), although it did reveal a difference in TVF (1.97; 1.18-3.29). CD4+ lymphocyte recovery was equivalent for both LS and non-LS patients (159 vs 173).
  
  
  CONCLUSIONS
  In our cohort, immigrant status was not shown to be related to late initiation of HAART. Although LS patients did not have a longer TTF for any reason, TVF was significantly shorter. Despite universal free access to HAART in Spain, measures to ensure early diagnosis and treatment of HIV infection are necessary.
authors.affiliation: Servicio de Enfermedades Infecciosas, Medicina Tropical, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain. jose.perezmolina@gmail.com
authors.forename: J A
authors.initials: JA
authors.lastname: Pérez-Molina
authors.forename: I
authors.initials: I
authors.lastname: Suárez-Lozano
authors.forename: A
authors.initials: A
authors.lastname: Del Arco
authors.forename: R
authors.initials: R
authors.lastname: Teira
authors.forename: P
authors.initials: P
authors.lastname: Bachiller
authors.forename: E
authors.initials: E
authors.lastname: Pedrol
authors.forename: E
authors.initials: E
authors.lastname: Martínez-Alfaro
authors.forename: P
authors.initials: P
authors.lastname: Domingo
authors.forename: A
authors.initials: A
authors.lastname: Mariño
authors.forename: E
authors.initials: E
authors.lastname: Ribera
authors.forename: A
authors.initials: A
authors.lastname: Antela
authors.forename: J
authors.initials: J
authors.lastname: de Otero
authors.forename: V
authors.initials: V
authors.lastname: Navarro
authors.forename: Juan
authors.initials: J
authors.lastname: González-García
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015331:Cohort Studies; D054242:Emigrants and Immigrants; D005260:Female; D006678:HIV / Q000254:growth & development*; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013030:Spain; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents